Who's Really Serious About Fixing Health Care?

Approximately 20-30 percent of what we do as doctors is unnecessary according to new reports from highly-respected doctors. How can politicians really talk about addressing healthcare costs -- the driver of our national debt -- if only a few bold doctors are talking openly about the elephant in the room?

Rising medical prices are not only a heavy burden on U.S. businesses struggling to be competitive with those overseas, but they are also a giant levy on the take-home income of Americans. Considering both direct and indirect monies you spend on health care, you are paying a ton: 21 cents of every dollar you pay in taxes, PLUS your health insurance bill, PLUS taxes going toward the interest on an indebted Medicare/Medicaid system. That's a lot of money. And what do you see for your money? Increasingly, patients describe to me their frustrations over a industry they can't evaluate. I recently had a patient tell me that she choose my hospital because "The parking was easy." We can do better than that. Medicine represents one-fifth of the U.S. economy. And for some reason we as a society allow the competition in this free market to occur at the wrong-level.

People seeking health care often feel that they are forced to walk in blind, not knowing which hospitals perform well and which are bad outliers. Yes, you can choose where to go for your health care but in reality, you often have had no useful information to make your decision. Until now.

Increasingly websites are using doctor-endorsed methods of measuring hospital quality to guide patients. Soon these websites will be as centralized and well-known as sites like Trip Advisor, which revolutionized the travel industry, with a renewed focus on customer service. Moreover, in any industry, measuring quality is a tide that raises all boats. In health care, it is a badly needed reform that can make modern medicine safer, more accountable, and more efficient.

Waste is a new term we use in health policy circles which captures dangerous and unnecessary medical care. It hasn't been discussed much for the reasons Dr. Brian Goldman explains in his TEDTalk, but it's a gigantic problem. In my opinion, as a busy surgeon, it's the elephant in the room. In fact, medical mistakes and preventable infections are now the number three cause of death in the United States. We spend a lot of time, energy and money on numbers one and two (Cardiovascular disease and cancer respecitively), but we don't even have a culture which promotes an honest discussion about number three. Most recently, after writing Unaccountable, I received thousands of emails, letters, and calls from Americans who have a personal story. They describe themselves or a loved one harmed because of overtreatment or a medical mistake, or both. They also describe how there was no one person seemed to be malicious, only a system which left them in the dark.

A recent Mayo clinic study found that 46 percent of our nation's doctors are burned out. In what other industry would we expect high-quality and efficient service where 46 percent of the front line personnel are burned out? I've asked doctors around the country why they believe burnout is rampant in medicine. The answers I hear are often the same. The pressure to do more, the mounting red tape, and the sense that they no longer own the care of their patients. They also feel that their feedback is not solicited and that there is not a culture of openness to share their concerns about the quality and safety of how medical care is delivered.

Doctors and nurses are now beginning to speak up about this epidemic. In a modern health care "transparency" revolution, we are seeing respected leaders speak openly about the issue, and how it has bothered them to be silent about it for so many years. The American Board of Internal Medicine has issued a formal report listing the five most common unnecessary tests and procedures in each specialty, with a stern warning to the public: If you are told you need one of these, beware, and get a second opinion. We now have the nation's largest heart surgeons group partnering with Consumer Reports to make hospital outcomes available to prospective patients seeking care. While in it's infancy, medical professionals are now saying we can't fix health care and it's cost crisis if we can't be open and honest that we even have a problem.

If we are going to get serious about addressing our national debt, we need to listen to our nation's doctors and talk about the elephant in the room. While most efforts to fix health care have focused on new ways to finance it differently, many of us on the front lines of medicine believe that we can't just talk about how different ways to pay for health care, we need to start talking about different ways to fix health care.

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